Traumatic Brain Injury Epidemiology in Brazil.

BACKGROUND: Traumatic brain injury (TBI) stands out as a grave social and economic problem. Emerging countries possess few epidemiologic studies on the range and impact of TBI. OBJECTIVE: Our study aimed to characterize the demographic, social, and economic profile of people suffering from TBI in Brazil. METHODS: Data on TBI cases in Brazil between 2008 and 2012 were collected through the website of the Information Technology Department of the Unified Health System (DATASUS) maintained by the Brazilian Ministry of Health. This database is fed by public hospital admission authorization forms provided nationwide. RESULTS: There were around 125,000 hospital admissions due to TBI a year, an incidence of 65.7 admissions per 100,000 inhabitants per year. Hospital mortality was 5.1/100,000/year, and the case fatality rate was 7.7%. The average annual cost of hospital expenses was US$ 70,960,000, with an average cost per admission of US$ 568. The age group 20-29, frequently admitted to the hospital due to TBI, presented the largest number of hospital deaths; however, the population >80 years of age showed the highest admission rate per age group, around 138/100,000/year, followed by the age group 70-79. CONCLUSIONS: TBI should be recognized as an important public health problem in Brazil because it is responsible for considerable social and economic costs. Besides the young adult age group (20-29 years old), the geriatric age group is especially vulnerable to the frequent and devastating consequences of TBI. The implementation of a system of effective epidemiologic vigilance for neurotrauma is urgent in Brazil and other countries worldwide.

Efficacy and safety of a porcine collagen sponge for cranial neurosurgery: a prospective case-control study.

OBJECTIVE: The use of dural grafts is very useful when primary dural closure cannot be achieved. Our primary objective was to study the incidence of postoperative cerebrospinal fluid leak, including fistula and pseudomeningocele, and postoperative infection by comparing autologous material and a new collagen graft. MATERIALS AND METHODS: A prospective nonrandomized study with a new collagen-based product derived from porcine cells (Peridry) was performed. It was used for dural replacement in 50 patients who underwent a variety of neurosurgical procedures requiring the use of a dural graft. These results were compared with a control group of 50 patients who were treated with autologous duraplasty material. The follow-up period was 3 months. RESULTS: Postoperative overall cerebrospinal fluid fistula occurred in 6% of both groups. No patient in the collagen group developed any sort of infection. One patient in the control developed osteomyelitis in the bone flap. CONCLUSION: The new collagen-based product derived from porcine cells (Peridry), compared with an autologous tissue, is safe, effective, easy to use, as well as time saving in cranial neurosurgery.

Monitoring of activated coagulation time in carotid endarterectomy.

BACKGROUND: The objective of the present study was to evaluate the efficacy of monitoring activated coagulation time (ACT) during carotid endarterectomy (CEA) in reducing surgical risks and complications. METHODS: A total of 175 consecutive patients who had CEA between July 2002 and January 2004 were studied. Activated coagulation time was monitored during the procedure in all patients. The results were compared with the data reported in the literature, and with those obtained in 2 previous series, totaling 1924 patients treated at the same service before the use of ACT. RESULTS: Only 4 of the 175 patients had cerebral ischemia, with 3 of them almost completely recovering during hospitalization. Significant morbidity was 0.6% and mortality was 0.6%. No statistically significant difference in the incidence of cerebral ischemia or death was observed between symptomatic and asymptomatic patients. In the 2 previous series used for comparison, operated by the same author, we found 0.7% and 0.8% of significant morbidity and 1.4% and 2.6% of mortality, respectively. Most series in the literature have shown a higher significant morbidity than the present one, mainly in symptomatic patients. The incidence of hematoma in the present series was 5.7%, only 3 (1.7%) of them being significant. No increase in the frequency of hematomas was observed in cases where heparin was not reversed or in those using a shunt. In the 2 other previous series, the incidence of hematomas was 1.5% and 3.6%. CONCLUSIONS: Activated coagulation time monitoring during CEA was effective in evaluating the level of heparinization of patients during surgery and the immediate postoperative period. The comparison of the present series with the literature and with the previous series of the same service, before the use of ACT, permits also to conclude that the control of the level of heparinization seems to reduce the risk of perioperative and immediate postoperative ischemia. In addition, ACT monitoring also seems to be effective in diminishing the risk of postoperative cervical hematoma.